Q&A

An insightful discussion with Dr. Leonard Epstein, a psychologist at the University at Buffalo, who focuses on changing health behaviors.

NIHNiH: Why are family-oriented approaches effective?

Epstein: Obesity tends to run in families, often passed down through generations. I’ve found that treating both the parent and child at the same time yields stronger results. It supports better outcomes for everyone involved and is more efficient than addressing adults and children individually with different specialists.

It's not very effective for a doctor to merely advise a parent to keep junk food out of the house if the adult isn’t also making healthy changes. A child won't take the advice seriously if the parent is saying “don’t eat that” while eating candy themselves.

Our program teaches kids to become more aware of what they eat and how active they are. They learn to set and reach goals. Parents have their own goals too—like offering praise when a child eats nutritious food or chooses to be active. It’s important to avoid making the parent into a strict monitor of food choices.

When a parent constantly interrogates a child about what they’ve eaten or criticizes their choices, it often backfires. Instead, focusing on stocking only healthy foods at home makes every choice a good one. If a child picks a healthy snack and the parent responds positively, the child gains confidence and motivation. This strengthens their relationship and encourages continued good habits.

NIHNiH: What are the difficulties involved in preventing childhood obesity?

Epstein: Children naturally gain weight as they grow. They also start to eat more. Young children often act on impulse—they want immediate rewards. As they mature, they begin to understand that it’s sometimes better to wait for a greater benefit later.

Prevention means making choices now for benefits down the road. Kids gradually learn this skill over time, and it doesn’t fully develop until their twenties. Foods like sweets are instantly satisfying, which makes them more appealing. Physical activities are not always fun right away—especially sports that require skill. They may only become enjoyable after a certain level of ability is reached.

Today’s environments tend to encourage inactivity. Choosing to watch TV is often easier than going for a walk. If two people go walking, one who exercises regularly might enjoy it, but the one who’s out of shape might find it tiring or uncomfortable. Over time, people need to adjust to the discomfort of activity before the enjoyable parts become more apparent.

NIHNiH: What helps encourage children to be more active?

Epstein: One of the strongest indicators of a child’s activity level is how active their parents are. When kids live in inactive households, a sedentary lifestyle becomes the norm. Finding fun activities that both children and parents enjoy together—like biking or walking—can make a big difference. Friends also play a role, since kids usually spend time with others who have similar habits.

The challenge is figuring out how to make being active more rewarding for those who aren't used to it, whether they’re kids or adults. That’s still an open question many are working to solve.